POSTOPERATIVE CARDIAC RHYTHMS WITH SUPERIOR-SEPTAL APPROACH AND LATERAL APPROACH TO THE MITRAL-VALVE

Background. The superior-septal approach provides an excellent view of the mitral valve and therefore has received considerable interest. Ho wever, the safety of this approach is controversial because it require s division of the sinus node artery in most eases. Methods. Postoperat ive cardiac rhythms were analyzed in 152 consecutive patients who unde rwent mitral valve procedures between January 1992 and February 1995 w ith a conventional right lateral left atriotomy (group 1, n = 69) or t he superior-septal approach (group 2, n = 83). Follow-up ranged from 2 to 38 months, and the mean follow-up was 16.1 months in group 1 and 1 3.8 months in group 2. Results. The mortality rate was similar in the two groups (1.4% in group 1 and 1.2% in group 2), and the causes of de ath were not related to the left atriotomy. At discharge, 96% of the p atients in group 1 who were in sinus rhythm preoperatively and 78% of those in group 2 remained in sinus rhythm. At the last follow-up, 88% of these patients in group 1 and 83% in group 2 remained in sinus rhyt hm. Among the patients in atrial fibrillation or junctional rhythm bef ore operation, 12% in group 1 and 11% in group 2 had regained sinus rh ythm at the last follow-up. There were no significant differences in t hese values. Conclusions. Although the incidence of dysrhythmias was h igher with the superior-septal approach in the early postoperative per iod, this approach provides an excellent operative view of the mitral valve and similar results in terms of late postoperative cardiac rhyth ms as the right lateral left atriotomy.